=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043019524
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILLBRAE HARMONY HOUSE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2025
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 192 AVIADOR AVE
-----------------------------------------------------
City | MILLBRAE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94030-2752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-890-6437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 675 3RD LN
-----------------------------------------------------
City | SOUTH SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94080-3509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-890-6437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WAIFUNG SIT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 408-890-6437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TA0700X
-----------------------------------------------------
Taxonomy Name | Adult Development & Aging Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------